Expanding view of aldosterone action, with an emphasis on rapid action

1. The actions of aldosterone beyond the 'mineralocorticoid' designation continue to attract intense interest. In recent years, two aspects have received particular attention. These are, first, the potentially damaging direct actions of aldosterone on the heart and vascular system, and the clear benefit, as illustrated by the Randomized Aldactone Evaluation Study and Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival trials, of including antialdosterone therapy in the treatment of cardiovascular disease. 2. Second, the importance of non-genomic actions of aldosterone has become clear, some of which might possibly be mediated by distinct membrane receptors. Over the past 5 years, evidence has arisen to bring these two aspects together, and now emphasizes the role of rapid, nongenomic actions of aldosterone on cardiovascular events. 3. However, despite many years of study, there is still no clear view of the nature of the receptors mediating non-genomic responses. We examine the evidence, and suggest that in many cases non-genomic actions are attributable to classical mineralocorticoid receptors.